Since increased hepatic fat, the pathological hallmark of NAFLD, negatively influences insulin signaling [27] and is associated with activation of fibrogenesis [28], we hypothesized that the Leu162Val variant of PPARα, previously associated with decreased hepatic lipolysis, dyslipidemia and type 2 diabetes (table 1), could influence liver damage in NAFLD [29]. This evidence concerns the gene INS and metabolic dysfunction-associated steatotic liver disease.